Our signature capabilities.
What each capability actually means, what the work involves, and when a health plan needs it.
Enterprise Program & Delivery Leadership
Enterprise-scale program leadership delivering clarity, control, and on-time outcomes.
What it is: Taking accountability for a multi-workstream program from mandate through production, and holding it together across the vendors, departments, and systems it touches.
When you need it: Work spans more than one team or vendor, an external date governs the outcome, and leadership is getting conflicting answers about where the program actually stands.
Program governance and cadence
A decision-making structure that matches the size of the program: who decides what, at what forum, on what evidence, and how quickly. Steering committee design, working group structure, and reporting rhythm that produces decisions rather than status.
Integrated planning and dependency management
One plan across every workstream, with the hand-offs made explicit. Critical path identified, dependencies owned by name, and the sequencing tested against real capacity rather than an idealized schedule.
Risk, issue, and decision management
Active management rather than a log nobody reads. Risks quantified against schedule and cost, issues escalated on defined triggers, and decisions recorded so the program stops relitigating settled questions.
Executive and stakeholder alignment
Reporting that tells sponsors what they need to act on, in the language they use. One version of program truth, consistent across the sponsor, the delivery teams, and the vendors.
Vendor and systems integrator coordination
Holding third parties to the plan: statement-of-work alignment, deliverable acceptance, and the joint working structure that keeps an SI honest without turning the relationship adversarial.
Operational & IT Current-State Intelligence
Rapid, fact-based visibility into operations, technology, data, and risk.
What it is: A structured, time-boxed examination of how the work actually flows today, across process, systems, data, and people, producing an evidence-based picture rather than an anecdotal one.
When you need it: A transformation is being scoped, an acquisition needs integrating, or leadership cannot agree on what the underlying problem is because everyone is describing a different part of it.
Process discovery and documentation
How work moves in practice, not how the procedure manual says it moves. Hand-offs, workarounds, manual touches, and the undocumented steps that experienced staff perform from memory.
Application and data landscape mapping
What systems exist, what each one is actually used for, where they connect, and which are load-bearing. Includes shadow systems and the spreadsheets that quietly run critical processes.
Operational baseline metrics
Volumes, cycle times, error and rework rates, and cost to serve, measured rather than estimated, so improvement can later be proven rather than asserted.
Gap and root cause analysis
Separating symptoms from causes. A claims backlog is a symptom; the cause might be configuration, upstream data, staffing, or a policy decision made three years ago.
Prioritized remediation roadmap
A sequenced set of actions with effort, benefit, and dependency attached, split into what can be fixed now, what needs a project, and what requires a structural decision.
Core Platform Optimization
Stabilize and optimize the core platforms your business runs on, reducing risk, errors, and replacement cost.
What it is: Focused work on the core administrative systems that carry enrollment, benefits, provider data, and claims, improving how they are configured and operated rather than replacing them.
When you need it: Manual intervention is climbing, auto-adjudication has drifted down, releases keep introducing regressions, or a platform replacement is being considered before the current one has been properly tuned.
Configuration review and remediation
Examining how benefits, pricing, edits, and workflow rules are configured, and correcting the accumulated exceptions and overrides that quietly degrade throughput over years of change.
Auto-adjudication improvement
Identifying why claims fall to manual review, then addressing the causes in order of volume. Usually a mix of configuration, provider data quality, and edits that were never revisited after the reason for them expired.
Benefit and provider data integrity
The reference data that everything downstream depends on. Contract loading, fee schedules, network structures, and the reconciliation discipline that keeps them accurate as they change.
Release and regression discipline
Making platform changes safe to deploy: what gets tested, what gets automated, what gets checked after go-live, and how a bad release is backed out without a crisis.
Replacement and migration readiness
If a replacement genuinely is warranted, the preparation that decides whether it succeeds: data conversion sequencing, configuration decisions, and parallel testing scope.
Data Platform, Integration & Interoperability
Modern, scalable data integration enabling trusted, real-time enterprise insight.
What it is: Building and governing how data moves, both between internal systems and across regulated external exchange, so that what arrives is accurate, timely, and traceable.
When you need it: A regulatory API deadline is approaching, reporting numbers are disputed between departments, or years of point-to-point interfaces have produced a landscape nobody can safely change.
Integration architecture and standards
Moving from accumulated point-to-point connections toward a governed pattern, with standards for how new interfaces are built, documented, monitored, and retired.
Regulatory interoperability
The externally mandated exchange: FHIR-based APIs, EDI transaction sets, and trading partner requirements, delivered against dates that do not move and specifications that are audited.
Data quality and lineage
Knowing where a number came from and what happened to it along the way. Validation at the point of entry, reconciliation between systems, and the ability to trace a reported figure back to its source.
Reporting and analytics enablement
Making operational and regulatory reporting repeatable rather than reconstructed each cycle, with agreed definitions so two departments asking the same question get the same answer.
Trading partner onboarding
The operational side of exchange: connectivity, testing, certification, and the support model for partners once they are live.
QA Transformation & Testing Excellence
Quality engineered into delivery through governance, automation, and compliance.
What it is: Establishing testing as a discipline that runs alongside delivery rather than a phase bolted on at the end, covering strategy, environments, data, automation, and defect governance.
When you need it: Defects are being found in production, UAT consistently slips, there is no dependable regression suite, or release frequency has outgrown the ability to test manually.
Test strategy and governance
What gets tested at which level, what evidence is retained, and what the entry and exit criteria are for each stage, defined before the work starts rather than negotiated under deadline pressure.
Test data management
Realistic test data that exercises real conditions without exposing protected health information. Generation, masking, refresh, and the governance around who can access what.
Automation and regression coverage
Building a regression suite that earns its maintenance cost, targeted at the paths where failure is most expensive, and integrated into the release process rather than run on request.
UAT design and business engagement
Structuring user acceptance so business subject matter experts can realistically participate: scenario design, scheduling against their day jobs, and triage that keeps defects moving.
Defect triage and release readiness
A defect process with agreed severity definitions and a go/no-go conversation grounded in evidence rather than optimism.
New Market & Program Launches
On-time, compliant launches into new markets, products, and regulated programs.
What it is: End-to-end readiness for entering a new line of business, geography, or regulated program, where a fixed external date governs every dependency and partial readiness is not an option.
When you need it: A new state contract has been awarded, a new product or population is being added, or an acquisition brings members who must be served correctly from day one.
Readiness assessment and gap closure
Establishing what the program requires against what currently exists, across operations, systems, network, and compliance, then closing the gaps in dependency order.
Regulatory and filing coordination
Tracking the submissions, approvals, and evidence a regulator expects, and keeping the internal work aligned to those dates rather than to internal convenience.
Operational readiness
The functions that must work on day one: enrollment, member materials, provider network, customer service, claims, and appeals, each staffed, trained, and rehearsed.
System configuration and testing
Benefit builds, provider and pricing setup, eligibility handling, and the end-to-end testing that proves a member can enroll, be identified, receive care, and have a claim paid correctly.
Go-live command and stabilization
A defined command structure through launch, daily monitoring against agreed measures, and rapid resolution of the issues that only appear once real volume arrives.